Lymphoma - Hodgkin - Childhood: Stages and Groups

Approved by the Cancer.Net Editorial Board, 08/2015

ON THIS PAGE: You will learn about how doctors describe a cancer’s growth or spread. This is called the stage. In addition, you will find information on the grouping of the disease. To see other pages, use the menu on the side of your screen.

Staging is a way of describing where the cancer is located, if or where it has spread, and whether it is affecting other parts of the body. Doctors use diagnostic tests to find out the cancer's stage, so staging may not be complete until all of the tests are finished. Knowing the stage helps the doctor to decide what kind of treatment is best and can help predict a patient's prognosis, which is the chance of recovery. There are different stage descriptions for different types of cancer.

After the diagnostic tests—described in the Diagnosis section—are completed, the doctor will assign a stage, which is needed to plan treatment. The four stages of Hodgkin lymphoma (I to IV; one to four) are described below.

In addition, each person’s disease is put into one of two categories, “A” or “B”, based on whether the person has symptoms of unexplained fever (at least 100.4 degrees Fahrenheit or 38 degrees Celsius for 3 consecutive days), drenching night sweats, or weight loss of 10% or more in the six months before diagnosis. “A” means the patient does not have these symptoms, while “B” means that the patient has at least one of these symptoms. Another category is “E” which means that the cancer has spread from the lymph node system to nearby tissues or organs.

Stage I: Cancer is in only one area of the lymph nodes or in one area or organ outside of the lymph nodes.

Stage II: Cancer is in two or more lymph node areas on the same side of the diaphragm, or cancer is in one lymph node area and in one area or organ next to the lymph nodes.

Stage III: Cancer is in lymph node areas above and below the diaphragm. The cancer may have spread to an area or organ near these lymph nodes and, possibly, to the spleen.

Stage IV: Cancer has spread outside of the lymph node system to the lungs, liver, bones, bone marrow, or other organs.

Recurrent: Recurrent cancer is cancer that has come back after treatment. If the cancer does return, there will be another round of tests to learn about the extent of the recurrence. These tests and scans are often similar to those done at the time of the original diagnosis.

Risk grouping

A treatment regimen, which is your child’s treatment plan, may be selected based on the disease’s classification as low, intermediate, or high risk. This classification is based on several factors, including the cancer’s stage, whether the tumor is bulky, and whether the patient is experiencing specific symptoms. Those symptoms are defined as “A” or “B”, as explained above.

  • In low-risk Hodgkin lymphoma children, usually have stage IA or stage IIA disease without bulky tumors.

  • In high-risk Hodgkin lymphoma, the cancer is in a later stage or is causing B symptoms like fever, drenching night sweats, or weight loss. This could include stages IIIB and IVB.

  • Other patients are usually considered intermediate risk.

Used with permission of the AJCC, Chicago, Illinois. The original source for this material is the AJCC Cancer Staging Manual, Seventh Edition, published by Springer-Verlag New York,

Information about the cancer’s stage and risk group will help the doctor recommend a specific treatment plan. The next section in this guide is Treatment Options. Or, use the menu on the side of your screen to choose another section to continue reading this guide.